tbuckley/cabot-search huggingface dataset:
Disparities in outcomes among hospitalized unhoused patients with cancer in the US.
Authors: Kanan Shah, Patricia Mae Garcia Santos, Justin Michael Barnes, Anna Tao, Chiaojung Jillian Tsai, Fumiko Chino
Journal: Journal of Clinical Oncology (2023)

6502 Background: Cancer is the 2nd leading cause of death among death among unhoused adults in the US. Use of aggressive medical interventions and costs during hospitalizations remains unstudied in the unhoused population. Methods: All hospitalized adults age ≥18 with a principal cancer diagnosis were identified in the 2016-2020 National Inpatient Sample (NIS). Logistic regression tested associations between unhoused status and: cost of care, mortality, and receipt of invasive procedures/systemic therapy. Adjusted analysis accounted for patient demographics, socioeconomic status, comorbidities, and effect modification of housing status by length of stay (LOS). Results: A total of 9,030 unhoused and 2,758,693 housed adults with cancer were included in the study. There were significant ( p&lt;0.01) differences in age &lt;65 years (77% unhoused vs 41% housed), male sex (75% vs 53%), race (Black, 25% vs 13%; White, 58% vs 71%), and insurance type (Private, 6% vs 27%; Medicaid, 53% vs 11%). There were also differences by primary cancer diagnosis, with higher rates of lung (17% vs 14%) and liver (8% vs 3%) cancers. Unhoused persons received less chemotherapy inpatient (5% vs 7%) and fewer overall procedures (48% vs 58%), while experiencing longer LOS (median 6 vs 4 days). On adjusted analyses, unhoused adults were had lower odds of receiving invasive procedures (aOR [95%CI], 0.34 [0.27-0.42]) or systemic therapy (0.41 [0.20-0.85]); and were less likely to have a higher-than-median cost of stay 0.47 [0.39-0.57]). Additionally, unhoused adults were 35% and 20% less likely to have a higher-than-median cost of stay or die while hospitalized (95% CI 0.59 – 0.71 and 0.67 – 0.96, respectively). When accounting for the possibility of housing status being modified by LOS, unhoused persons remained significantly less likely than housed persons to receive inpatient procedures (aOR 0.38, 0.47, and 0.60 for short, medium, and long LOS, respectively; p&lt;0.001 for each) or have high cost of stay (adjusted OR 0.55, 0.71, 0.70, p&lt;.001 for each), though the differences by housing status were attenuated with longer length of stay. Conclusions: In this first nationwide analysis of hospitalizations among unhoused adults with cancer, unhoused patients remained significantly less likely to receive invasive procedures or systemic therapy. These disparities in inpatient management despite the higher prevalence of more aggressive cancers and comorbidities among the unhoused highlight missed opportunities to improve cancer care.
Factors that determine selection of a cancer treatment location.
Authors: Ann Francis, Taylor Teschner, Prem R. Warde, Melissa Johlie, Lynn Buthe, Kjel Andrew Johnson
Journal: Journal of Clinical Oncology (2023)

e18880 Background: Cancer patients, who are already overwhelmed by their diagnosis and other decisions that need to be made, are also confronted with decisions regarding treatment options. Understanding factors that influence a cancer patient’s decision to select a treatment location are needed to optimize treatment decision-making and avoid financial toxicity. This study aimed to gather feedback from cancer patients to understand what factors influence their decision to choose a cancer treatment location. Methods: We conducted an online cross-sectional survey of 126 current and former cancer patients. We asked what factors influenced their decision to select their current or former cancer treatment center. The survey was conducted in 2022; descriptive statistics and percentages are reported. Results: Most patients were White (87%), female (74%), college-educated (70%) and resided in the suburbs (57%); hypertension (32%) was the most common comorbidity. The most common cancers were breast (48%), followed by colon or rectal (8%) and leukemia (8%). Roughly half of the patients selected the location for screening (51%), while someone else selected locations for diagnosis and staging (63%), treatment plans (64%) and treatment (45%). Of those who indicated that someone else chose their screening, diagnosis and staging, treatment plan and treatment locations, most reported their oncologist decided the diagnosis and staging (57%), treatment plan (86%) and treatment locations (90%). The wait time to receive treatment (89%) and distance from home or work (86%) were the two most important factors when selecting a cancer treatment location. Over half (57%) of patients said they would be “very willing” or “somewhat willing” to change treatment locations for a $0 copay/coinsurance offer. However, only 38% of respondents would be willing to change locations for a $0 copay/coinsurance offer if it meant they would have to change oncologists. 48% of patients were willing to drive 41-100 miles to a treatment location for a $0 copay/coinsurance offer. 74% of patients received an infusion as part of treatment; over half (57%) preferred to receive the infusion in a suite at a cancer center/clinic. Conclusions: While primary care physicians and oncologists share almost equally in selecting screening locations, oncologists are most often responsible for recommending a treatment location for the other three steps (diagnosis and staging, treatment plan and treatment) in the cancer treatment journey. When offered a $0 copay/coinsurance program during treatment, patients were willing to change locations, highlighting the impact of cost on selecting a cancer treatment location. However, patients were less likely to change locations if that meant changing their oncologist, highlighting the importance of trust and comfort in one’s oncologist.
Identifying the education, information and support needs of Canadians diagnosed with breast cancer: A Canadian Breast Cancer Network (CBCN) assessment project.
Authors: Cathy Ammendolea, Kathleen Dickerson Swiger, Scott Richter, Bukun Adegbembo
Journal: Journal of Clinical Oncology (2023)

e13088 Background: Assessing the education, information and support needs of Canadians diagnosed with breast cancer involves categorizing and tailoring topics and methods of delivery but, most importantly, it must be rooted in an understating of the patient. In 2022, CBCN initiated a project to identify the needs of the Canadian breast cancer population and develop tailored, focused programs and materials. Methods: CBCN conducted a series of 45-minute key informant interviews (7) with patients and oncologists to determine needs, gaps, programs and materials. Five 90-minute patient focus groups (32 participants) were conducted to enhance the interviews. One group was specifically for metastatic patients. Findings from the interviews and focus groups were used to inform the questions for a survey which was fielded online May1/June 10, 2022. The data analysis began in September 2022 and is on-going. Results: A review of Canadian triple negative breast cancer (TNBC) patients’ responses (n=185 or 18.9% of respondents) showed that only 29.4% had heard the term TNBC before. When asked about educational resources on clinical, practical and support topics TNBC patients preferred them tailored to their breast cancer type (94.3%). TNBC patients reported difficulty locating resources (74.0%) and rated those available satisfactory to poor (44.6%). Sources included websites, social media and printed materials. Specific topics of interest were new treatments and latest research (66.2%), fear of recurrence (63.1%), prevention of illness after breast cancer (60.1%) and long term effects of treatment (57.4%). Conclusions: Public awareness of the types of breast cancer could promote a better understanding of the nature of the disease. Availability of multiple communication channels provides opportunities to disseminate and update resources and deliver them to the patients and providers. While information exists, identifying and increasing the availability of credible, reliable resources tailored to specific types of breast cancer that are easily accessible to both patients and clinicians could enhance the physician-patient dialogue, potentially improve adherence, promote trust and possibly contribute to improved outcomes.
Neoadjuvant camrelizumab plus chemotherapy for locally advanced cervical cancer (NACI study): A prospective, single-arm, phase II trial.
Authors: Jing Chen, Kezhen Li, Yingjie Hu, Yingyan Han, Yuanming Shen, Yanzhou Wang, Kun Song, Bairong Xia, Xiaojun Chen, Dongling Zou, Yingmei Wang, Chaoyang Sun, Gang Chen, Ding Ma
Journal: Journal of Clinical Oncology (2023)

5520 Background: First-line treatments for locally advanced cervical cancer (LACC) have limited efficacy and neoadjuvant chemotherapy (NACT) is an emerging approach, however, two-thirds of patients (pts) respond to it and pts without response benefit little. PD-1 inhibitors have shown promising role in recurrent or metastatic cervical cancer. This study aims to evaluate the efficacy and safety of preoperative PD-1 inhibitor camrelizumab combined neoadjuvant therapy for LACC. Methods: The study is designed as a multicenter, open-label, single-arm, prospective phase II study. Pts are enrolled if they had previously untreated LACC (2018 FIGO staged IB3, IIA2 and IIB/IIIC1r (tumor size &gt; 4cm). Eligible pts will receive neoadjuvant chemo-immunotherapy (NACIT), defined as one cycle of cisplatin (75-80 mg/m2, iv) plus nab-paclitaxel (260 mg/m2, iv) NACT and subsequent two cycles of camrelizumab (200mg, iv) combined NACT. Either surgery or concurrent chemoradiotherapy are conducted according to the response as per the Response Evaluation Criteria In Solid Tumors (RECIST) version 1.1. The primary endpoint was objective response rate (ORR), and the secondary endpoints were pathological complete remission (pCR) rate, rate of postoperative adjuvant treatment, event-free survival, overall survival and safety. Results: From Dec 1, 2020 to Feb 1, 2023, 83 pts were enrolled, and 78 pts were evaluated for response. The ORR was 100% (95%CI, 95.38 to 100), with 14 (17.95%) complete response (CR) and 64 (82.05%) partial response. Regarding the pathological findings of 76 pts who underwent radical surgery, 30 (39.47% (95%CI, 28.44 to 51.35)) pts achieved pCR, while 17 (22.37%) needed postoperative adjuvant treatment as indicated in NCCN guideline, of who 14 had positive pelvic nodes, positive surgical margin, and/or positive parametrium and the other three met Sedlis criteria. RECIST CR was significantly associated with pCR ( P = 0.016). Pre-treatment PD-L1 expression (Combined Positive Score) was a predictive biomarker for RECIST CR ( P = 0.036) but not for pCR ( P = 0.078) in these evaluated patients. Grade 3 or 4 treatment-related adverse events occurred in 35 (44.87%) pts during NACIT; the most common were lymphocytopia (25.64%), neutropenia (12.82%) and leucopenia (8.97%). Conclusions: NACIT for LACC demonstrated extremely high ORR and pCR rate with manageable toxicity profile, and greatly reduced the need of postoperative adjuvant therapy. Clinical trial information: NCT04516616 .
Salvage ipilimumab plus nivolumab in advanced hepatocellular carcinoma after prior anti-PD-(L)1 blockade.
Authors: Stephanie Leigh Alden, Mir Lim, Chester Kao, Daniel Shu, Amit G. Singal, Anne M. Noonan, Paige Griffith, Marina Baretti, Won Jin Ho, Ihab R. Kamel, Mark Yarchoan, David Hsiehchen
Journal: Journal of Clinical Oncology (2023)

4091 Background: Combination PD-(L)1/CTLA-4 blockade is approved in patients with advanced hepatocellular carcinoma (HCC) in the first line or after treatment with sorafenib, but it is unclear if combination therapy has efficacy after treatment with anti-PD-(L)1 alone or in combination with a multikinase inhibitor. We evaluated responses to ipilimumab plus nivolumab in patients with advanced HCC who previously received anti-PD-(L)1 to assess the efficacy and safety of this regimen. Methods: We performed a multi-center retrospective review of patients 18 years of age or older with a diagnosis of HCC based on histology or imaging who had received at least one dose of anti-PD-(L)1 therapy prior to receiving ipilimumab plus nivolumab as a subsequent line of therapy. All patients had imaging and/or laboratory monitoring to monitor for disease progression. Results: Our cohort contained 32 patients, with a majority being male (88%, n = 28) and a median age of 67 years. All patients were Child Pugh A (66%, n = 21) or B (34%, n = 11) at the start of treatment, with most having an ECOG performance status of 0-1 (84%, n = 27). The median number of prior lines of therapy was 2 (range 1-8). Prior anti-PD-(L)1 containing regimens included atezolizumab plus bevacizumab (50%, n = 16), other VEGF plus anti-PD-(L)1 combination (31%, n = 10), and anti-PD-(L)1 monotherapy (19%, n = 6). The objective response rate (ORR) was 22% (1 CR, (3%), 6 PR (19%)), with remaining responses including 8 SD (25%), 16 PD (50%), and 1 NE (3%). Among patients who had an objective response to ipilimumab plus nivolumab, none had an objective response to prior anti-PD-(L)1 treatments. Response rates were similar across major clinical (obese vs. non-obese) and etiological (viral vs. non-viral) subsets of HCC. Response to ipilimumab plus nivolumab was associated with improved PFS and OS: median PFS for PD/SD/NE 2.4 months (95% CI: 2.1-NR) vs. PR/CR not reached (NR) (95% CI: 7.5-NR), p = 0.004, and OS for PD/SD/NE 5.9 months (95% CI: 3.1-NR) vs. PR/CR NR (95% CI: NR-NR), p = 0.02. Immune related adverse events (irAEs) were reported in 13 patients (41%), and 6 patients experienced grade 3-4 irAEs (19%). One patient in our cohort experienced a fatal irAE (autoimmune hepatitis), and 5 patients discontinued therapy due to irAEs. Conclusions: This study demonstrates that ipilimumab plus nivolumab has clinical activity in patients with advanced HCC who previously received anti-PD-(L)1 therapy with an acceptable safety profile, supporting this regimen as second line immune checkpoint inhibitor therapy in advanced HCC. Further studies are required to determine the optimal sequence of therapies in advanced HCC.
Identification of factors to predict low risk febrile neutropenia admissions in patients with acute myeloid leukemia (AML) following intensive chemotherapy.
Authors: Khushboo Pal, Zahra Ali, Megan Othus, Katie Russell, Carole Shaw, Mary-Elizabeth M. Percival, Paul Hendrie, Roland B. Walter, Anna B. Halpern
Journal: Journal of Clinical Oncology (2023)

7031 Background: Febrile neutropenia (FN) is the most common reason for hospital readmission following chemotherapy for AML. Standard practice for FN in AML is hospitalization for rapid administration of IV antibiotics, thus FN is a major driver of healthcare resource utilization and cost. Whether this approach is justified in all situations is unknown. While FN risk models have been developed focusing on solid tumors, factors predicting uncomplicated courses of FN in AML, which may allow identification of patients suitable for outpatient management, have not been studied. We therefore examined whether baseline clinical characteristics could predict which AML patients with FN have a lower risk of progression to severe illness. Methods: We retrospectively reviewed medical records from 7/29/2014-12/24/2022 to identify adults with FN (fever &gt;38.3C and white blood count &lt;1000/µL). Included were patients with high-grade myeloid neoplasm (&gt;10% blasts in blood/marrow) who received intensive chemotherapy (cytarabine dose &gt;=100 2 /day) within 8 weeks. We collected baseline clinical and disease variables. Outcomes were: infections identified, hospital length of stay (LOS), intensive care unit (ICU) admission, and survival. A “low-risk [LR]” outcome was defined as a LOS &lt;72hrs without ICU admission or inpatient death. Univariate and multivariable (MV) logistic regression models were used to assess covariate associations with outcomes. Results: We identified 350 FN admissions in 198 patients with a median age 62 (range: 21-87) yrs. 63% were newly diagnosed and 37% relapsed/refractory. 12% had prior transplant. Median duration of neutropenia prior to fever was 12 (1-287) days. 46% had transfusion &lt;24 hours prior to fever. The median LOS was 5 (1-56) days. 9% of patients went to ICU and 6% died inpatient.Overall, 15% of admissions were classified as LR. 57% had an infection identified. The table shows factors in MV analysis that predicted an infection identified or high-risk (HR) admission. Conclusions: Only 15% of AML admissions for FN were LR. Factors that predict HR outcomes in standard FN models such the MASCC score—e.g. age, prior fungal infection —were not predictive of HR outcomes in AML. As a next step, we will compare our model to other published models used to predict poor outcomes after FN, which have not been developed or validated in AML. [Table: see text]
Effects of namodenoson on pancreatic carcinoma: Preclinical evidence.
Authors: Pnina Fishman, Avital Bareket-Samish, Inbal Itzhak
Journal: Journal of Clinical Oncology (2023)

e15134 Background: Namodenoson, an A3 adenosine receptor (A3AR) agonist, is currently in a phase 3 trial for the treatment of advanced liver cancer. The mechanism of action of namodenoson involves de-regulation of the Wnt and NF-κB signaling pathways, followed by an increase in pro-apoptotic proteins and Fas-ligand, resulting in tumor growth inhibition. As the Wnt signaling pathway is also highly implicated in pancreatic carcinogenesis, we examined the anti-growth effect of namodenoson on pancreatic carcinoma cell lines and investigated the molecular mechanism involved. Methods: BxPC-3 human pancreatic carcinoma cells were cultured in the presence and absence of 0.01, 0.1, and 1 nM namodenoson. A combined treatment of namodenoson (0.1 nM) and gemcitabine (0.2 µM) was also studied. 3 [H]-thymidine proliferation and MTT assays were used to monitor cell growth, and Western blot analyses were performed to identify the involved regulatory cell growth proteins. Results: Results of the 3 [H]-thymidine proliferation assays demonstrated significant dose-dependent inhibition of the growth of BxPC-3 cells with namodenoson (1 nM: 67.4% ± 1.7%, p &lt; 0.001; 0.1 nM: 53.7% ± 6.3%, p &lt; 0.05; 0.01 nM: 27.9 % ± 2.3%, p &lt; 0.005). The MTT results revealed that a combined treatment with namodenoson plus gemcitabine had an additive inhibitory effect (namodenoson: 48.6% ± 1.4%; gemcitabine: 44.4% ± 0.7%; namodenoson plus gemcitabine: 65.4% ± 1.4%; p &lt; 0.001 for all). Western blot analyses showed that namodenoson treatment was associated with downregulation of the Wnt pathway regulatory proteins including p-Akt, NF- κB, GSK-3β, and β-catenin. Conclusions: Our findings showed that nanomolar concentrations of namodenoson inhibit the growth of pancreatic carcinoma via A3AR activation and de-regulation of the Wnt/β-catenin pathway, both as a monotherapy and in combination with gemcitabine. Thus, these results support a potential role for namodenoson in treating pancreatic cancer, thereby opening a novel therapeutic opportunity for this disease.
Clinical and molecular characterization of HER2-low metastatic colorectal cancer.
Authors: Aryeh Babkoff, Tal Keidar Haran, Aviad Zick, Ayala Hubert, Albert Grinshpun
Journal: Journal of Clinical Oncology (2023)

e15573 Background: HER2 is a well-established biomarker and target in multiple tumor types, including metastatic colorectal cancer (mCRC). Despite the lack of HER2 amplification, certain HER2-low tumors were recently found to respond to novel HER2-directed antibody-drug conjugates, warranting an exploration of the clinical and molecular features of these entities. Yet, the real-world prevalence and the clinicopathologic characteristics of HER2-low mCRC are largely unknown. Here, we aim to describe the features of HER2-low mCRC and compare them to HER2-0 colorectal tumors. Methods: We retrospectively reviewed clinicopathologic data from consecutive patients with mCRC undergoing HER2 testing (immunohistochemistry [IHC] and in-situ hybridization [ISH], when appropriate) between 2017 and 2021 at Hadassah Medical Center, Israel. Tumors were defined HER2-positive (HER2+) if scored IHC 3 + or IHC 2+/ISH positive; HER2-low if scored IHC 2+/ISH negative or IHC 1+; HER2-0 if scored IHC 0. Genomic alterations were determined through a targeted next-generation sequencing (NGS) panel. Clinicopathologic and genomic data were compared between the cohorts with the Mann-Whitney or Fisher's exact test, and survival using Log-rank test. Results: A total of 100 consecutive mCRC patients were found eligible for our study, including 4 (4%) with HER2+, 30 (30%) with HER2-low, and 66 (66%) with HER2-0 disease. In the HER2-low group, five tumors were HER2 +2 / ISH negative, and 25 were scored HER2 +1. The fraction of female patients was 40% in HER2-low group, and 42% in the HER2-0 cohort (p &gt; 0.99). The prevalence of mismatch repair deficient (MMR-D) tumors was also similar, with one MMR-D tumor in the HER2-low group, compared to 3 tumors in the HER2-0 (p &gt; 0.99). 60% of the primary tumors in both groups originated in the left colon and rectum. Also, the prevalence of mucinous histology was comparable between the HER2-low and the HER2-neg cohorts (7.4% vs. 4.8%, p = 0.64). Among patients receiving local somatic NGS testing (n = 61), the fractions of patients with KRAS, BRAF, and TP53 mutations were largely comparable between the cohorts (Table 1). With a median follow up of 37 months, the median overall survival was 41 months for the HER2-low group and 51 months for the HER2-neg group (p = 0.15). Conclusions: In our cohort of patients with HER2-negative mCRC, the clinicopathologic and genomic characteristics of HER2-low and HER2-0 tumors did not differ significantly. However, our data suggest that HER2-low tumors represent a significant portion of mCRC, supporting further development of novel HER2-directed therapies for this population. Additionally, our data also support the notion that HER2-low, as currently defined, is not a distinct molecular subtype of mCRC. [Table: see text]